前路中空螺钉内固定术与后路寰枢椎融合术治疗齿状突骨折的对比研究

A retrospective trial of anterior hollow screw fixation versus posterior atlantoaxial fusion for odontoid process fractures

目的：探讨前路中空螺钉内固定术与后路寰枢椎融合术治疗齿状突骨折的临床疗效及安全性。方法：回顾性分析45例齿状突骨折患者的临床资料，其中采用前路中空螺钉内固定25例，采用后路寰枢椎融合20例。比较2组患者的手术时间、术中出血量、疼痛视觉模拟评分、骨折愈合情况及颈椎活动度，并观察脊髓神经功能恢复情况。结果：所有患者均获随访，随访时间6—18个月，中位数12个月。术后3个月，所有患者疼痛等症状均消失；术后6个月，前路中空螺钉内固定组患者骨折均获得骨性愈合；后路寰枢椎融合组患者1例骨折愈合情况较差，于术后12个月随访时仍未完全获得骨性愈合（P=0．000）。2组中存在神经系统症状的患者，Frankel脊髓损伤分级均恢复至E级。前路中空螺钉内固定组的手术时间、术中出血量均小于后路寰枢椎融合组[（48．0±9．7）min，（120±16．3）min，t=2．323，P=0．031；（57．0±10．6）mL，（200．0±19．5）mL，t=4．241，P=0．002]。前路中空螺钉内固定组的疼痛视觉模拟评分与后路寰枢椎融合组相比，差异无统计学意义[（2．1±0．3）分，（1．9±0．4）分，t=0．524，P=0．635]。前路中空螺钉内固定组的颈椎屈曲、后伸、左旋、右旋角度均大于后路寰枢椎融合组[（40．3。±8．6。），（32．7。±7．8。），t=2．661，P=0．019]；（41．4。±9．2。），（34．6。±8．5。），t=3．723，P=0．011；（75．3。±4．7。），（5．9。±0．6。），t=2．091，P：0．001；（76．1。±6．1。），（7．1。4-0．7。），t=3．352，P=0．000]。结论：与后路寰枢椎融合术相比，采用前路中空螺钉内固定术治疗齿状突骨折，手术时间短、创伤小、术中出血量少、骨折愈合好、术后颈椎活动度好，值得临床推广应用。

Objective： To explore the clinical curative effects and safety of anterior hollow screw fixation versus posterior atlantoaxial fu- sion in the treatment of odontoid process fractures. Methods： The clinical records of 45 patients with odontoid process fractures were ana- lyzed retrospectively. Twenty-five patients （ group A） were treated with anterior hollow screw fixation, while the others （ group B ） were treated with posterior atlantoaxial fusion. The two groups were compared with each other in such parameters as operative time, blood loss, visual ana- logue scales（VAS） ,fracture healing status and the range of motion（ROM） of cervical vertebrae. The recovery of spinal nerve function were also observed. Results：All the patients were available for follow-up. The median follow-up period was 12 months （range, 6 -18 months）. Three months after surgery, the pain and other symptoms of all patients disappeared. Six months after surgery, the patients in group A got bony union, while one patient in group B had delayed union and hadni got bony 12 months after surgery（ P = 0. 000）. The spinal function were restored（ Frankel grade E）in patients with neurological symptoms in the two groups. The operative time and blood loss were less in group A compared to group B（48.0 ＋/-9.7 vs 120 ＋/- 16.3 min,t =2. 323 ,P =0. 031 ;57.0 ~/- 10.6 vs 200.0 ＋//- 19.5 mL,t =4. 241, P = 0. 002 ）. There were no statistical differences in the VAS between the two groups （ 2.1 ＋/- 0.3 vs 1.9 ＋/- 0.4, t = 0. 524, P = 0. 635 ）. The angles of forward flexion, backward extension, sinistral rotation and dextral rotation of cervical vertebrae were larger in group A compare to group B （40.3 ＋/- 8.6 vs 32.7 ＋/- 7.8 degrees, t = 2. 661, P = 0. 019 ;41.4 ＋//- 9.2 vs 34.6 ＋/- 8.5 degrees, t = 3. 723, P = 0.011 ; 75.3 ＋/- 4.7 vs 5.9 ＋/- 0.6 degress, t = 2. 091, P = O. 001 ;76.1 ＋/- 6.1 vs 7.1 ＋/- 0.7 degrees, t = 3. 352, P = 0.000 ）. Conclusion ： Compared with posterior atlantoaxial fusion, the therapy of anterior hollow screw fixation has such advantages as shorter operative time, less trauma, less blood loss, better fracture healing and wider postoperative range of motion of cervical vertebrae in the treatment of odontoid process fractures, so it is worth popularizing in clinic.